The PAB-technique = social work-instrument in multiproblem cases Stockholm 2012

1. The PAB-technique = social work-instrument in multiproblem casesStockholm2012 Herman de Mönnink, Netherlands www.mmsocialwork

2. Herman de Mönnink • 35 years Instructor School of Social Work • Social Workers’ Toolbox (2004) • Trauma-psychologist & grieftherapist in pp • Founder Study of Loss in NL (book 2010) • Unfinished Business Syndroom (UBS) • www.mmsocialwork.com

3. Overview presentation • Question • Assumptions theory SW-methods • Casestudy Mrs. Multiplex (39) • Definition PAB • Results PAB + other interventions • Conclusion

4. Question How can you as SW’er use the PAB-technique in multiproblem- client-situations?

5. Case Mrs. Multiplex (39) Referred by general doctor Will be thrown out of her home Social service blocked No overview in income/administration/ She does not react on calls Serious debts She is isolating from home and family Was treated by psychologist - depression 1 ½ years ago her son (19) died Intelligent woman

6. 1 Social Work-goals Stressreduction & empowerment on all levels

7. 2 In life you must do it yourself but not alone -individual -systemic -macro Empowerment www.mmsocialwork.coml

8. Social work symbol?

9. 3 Bio-psycho-social stressors vs strengths Individual-interpersonal-macro cycles.

10. iSET: integrated Stressreduction & Empowerment Theory

11. Multi-stressors = multi-method Individual stressors > 9 individual methods problemstress, existential -, cognitive -, emotional -, practical -, behavioral -, trauma-, grief-stressors Interpersonal stressors > 7 systemic methods Macrostressors > 4 macro-methods

12. SW-approach = always clientcentered Clientcentered = start, follow and end where the client is

13. Mrs. Multiplex: multiproblem & complex, where to start and where to end? Finance? No Income In ‘war’ with institutes Cooperation with institutes Institutions/procedures? Psychosomatic complaints Health ? Bad relation with spouse Relation spouse? Growing up children? No trust in others Social network? Laws and services? Strong tensions/emotions of son-loss Traumatic incidents? Depressed Psychological problems? Violence? Serious debts Debts? In debts-arrangement Housing? Threaths of losing her house Case management ? No insight of relation son-loss and multi-problems Insights?

14. SW approach in 3 steps 1. PAB (Personal Archive Box) 2. PSA (Psychosocial Stress Analysis) 3. PST (Psychosocial StressTreatment)

15. Step1 PAB: Personal Archive Box • Again: Start-follow and end where the client is!!!!!!!!!!!!!!!!!!!!!!! • Making contact and hearing clientstory • Summarise and visualise in PAB

16. Definition PAB Visualizing the clientstory by drawing the client and mark all stressors with minus (-) and all strenghts with plusses (+) in-words-of-the-client.

17. Step 1. PAB = Personal Archive Box • Mrs. • Multiplex • Serious debts • -Refuses to accept rules of social service • My son (19) died 3 years ago • Help: I loose my house… • I close myself • I do not speak with my spouse + Would like to have help from SW • I do not share my grief • I have grief and anger-attacks • Miss my son • - Psych did not help effectively + I feel a strong woman + I am physically healthy + Supported by my friend + Supported by general doctor

18. Step 2: PSA PsychoSocial Stress Analysis Individual & Social Strenghts? + Individual & Social Stressors -. strenghts stressors

19. PSA Mrs. Multiplex : unhealthy balance? strenghts (+) vs stressors (-) Individual strenghts + phyically health + Intelligent woman + Looks for SW-help Individual & social Stressors -Son died -Depths -No income -Threath of eviction -No energy -Depressed - Grief and anger -Discommunication with spouse, -No family-support and network -Strict rules and conditions social service dpt. Social strengths + Support by daughter + friend + Effective refer-system from general doctors to social work strenghts stressors

20. 3. PST: PsychoSocial StressTreatmentworking together for healthy balance Reduce individual & social stressors Empower Individual & social strenghts stressors strenghts

21. Scaling: stressmonitor 10 = I experience maximum of stress 1 = I feel totally relaxed Monitoring

22. Scaling: empowerment monitor 10 = I can help myself 1 = I cannot manage myself Monitoring

23. Progress Mrs. Multiplex by PABclientcentered multimethod social work Finance? Income is ok More in cooperation with institutes Cooperation with institutes Mediation? Reduction psychosomatic complaints Health care? Attachment with spouse improved Relation spouses? Grown up children? Getting more trust Social network? Laws and services? Releases tensions/emotions of son-loss Traumatic incidents? Not depressed anymore Psychological problems? Violence? Is in debts-arrangement Debts? In debts-arrangement Housing? No threath of losing her house Case management ? More insight of relation son-loss and multi-problems Insights?

24. PAB helps clients ordering, cleaning and clearing not only the real home but also the inner client-home Questions?

25. Contra-indications PAB • Urgent crisis (client urgently needs crisisintervention) • Client is physically and emotionally too weak • Insufficient cognitive functioning • Simple question/problem: no need for collection by PAB

26. PAB-technique: advantages? + Collecting & improving consciousness + Prioritize: stressors & strengths overview, no tunnelvision + Clarity about tasks to be done by the client and by the social worker + Client gets/holds direction in social work-contact + cl.life + Helps focussing: what is actual & old unfinished business + Monitoring progress: effective SW-approach with this cl.?

27. Step 2: PSA Mrs. Multiplex (39)

28. Psychosocial Stress Treatment (PST) Mrs. Multiplex Reduce inadequate coping with institutes Mrs. Multiplex is not obeying the rules Mrs M. reacts with anger on officials who threaten her with homelessness, cutting her off electricity Practical materialistic method Goal: reduce stressors by helping practically with housing and materialistic problems . Techniques: Informing, referrals, advocay, mediate, concrete help.

29. PST Mrs. Multiplex Reduce inadequate problem-coping and existential coping Don’t know no what to do with my life……..so start a war against Non-directive counseling-SW-method Goal: making time for dealing with the loss of her son and making up balance in questions like ‘why did this happen to me’? Technique: counseling to establish a working relation

30. PST Mrs. Multiplex Reduce unrealistic cognitive coping I will not share my grief, because they will not listen Cognitive SW-method Goal: unrealistic, negative, harmful thoughts of Mrs. M. about herself and the world are influenced to a realistic direction Technique: challenging-technique

31. PST Mrs. Multiplex Reduce inadequate behavorial coping I am pissed off when one is frustrating me Behavior SW-method Goal: learn assertive skills (not aggresive) Technique: social-skill-training

32. PST Mrs. Multiplex Reduce inadequate social interaction Mrs. M. is very unhappy and angry and destructive after losing her son. Refuses support and contact with family and network Refuses to share her grief with spouse and others Couple- and network-SW-method Goal: attach to spous and others in sharing grief and solving communication problems Technique: communication and LSE (Listen Summarize Empathy)

33. PST Mrs. Multiplex Reduce inadequate Services Rules are too strictly for crisisclients Psychopathologing depressed clients Macro-SW-methods Goal: structural improvement of cooperation between social services and clients; normalizing clients wityh grief Techniek: class advocasy and articles

34. PST Mrs. Multiplex Reducing emotional stress losing her son Mrs. M. is building up inside: grief, anger after losing her child Non- directive counseling, discharge-method & ritual-method Goals: hearing the clientstory and ackknowledge the tragedy and help her to discharge her feelings, and finish the emotional unfinished business Techniques: safetytechnique, miror-technique, say-goodbye-technique